2017 PQRS Negative Payment Adjustment Notification

October 3, 2016

PQRS participants are now being notified by letter regarding the 2017 CMS PQRS negative payment adjustment.

The CMS letter indicates that the recipient did not satisfactorily report 2015 PQRS quality measures or satisfactorily participate in a qualified clinical data registry (QCDR). Therefore, all of their 2017 Medicare Part B Physician Fee Schedule (PFS) payments will be subject to a 2.0% reduction.

  • The 2017 PQRS payment adjustment letter for individual Eligible Professionals (EPs) includes a Tax Identification Number (TIN)/National Provider Identifier (NPI) combination

    • The adjustment applies only to the individual EP associated with the TIN/NPI noted within the letter, and not the clinic or facility.

  • The 2017 PQRS payment adjustment letters for PQRS group practices includes a TIN only and applies to all EPs who have reassigned their billing rights to the TIN. Please check your letter in the upper left hand corner to determine if it contains your TIN or TIN/NPI.

The majority of eligible clinicians successfully reported PQRS in 2015 and avoided the negative payment adjustment. Medicare expects that trend to continue under the new MACRA Quality Payment Programs (MIPS and APM), which will begin on January 1, 2017.

To prepare your practice for the upcoming MACRA Quality Payment Program, be sure to review your PQRS feedback report and QRUR, and consider your options for joining a Qualified Clinical Data Registry. Also be sure to sign up for the live MACRA 101 webinar, hosted by CSMS on 11/16 and 11/22.

If I received the payment adjustment letter, what are my options?

If you believe that the 2017 PQRS negative payment adjustment is being applied in error, you can submit an informal review request

Informal review began on September 26, 2016, and closes on November 30, 2016, at 11:59 pm. CMS will investigate the merits of your informal review request and issue a decision within 90 days of receipt.

All informal review requests must be submitted via a web-based tool on the Quality Reporting Communication Support Page.

Please note: There are no hardship exemptions for the PQRS negative payment adjustment.

Clinicians are encouraged to access and review their PQRS feedback reports and 2015 Annual Quality and Resource Use Reports (QRURs) prior to submitting an informal review request. The 2015 Annual QRUR provides information about your TIN’s 2017 Value Modifier payment adjustment for physicians.

PQRS Resources

Questions? Please contact the QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) or at qnetsupport@hcqis.org. They are available from 7 am to 7 pm Central Time Monday through Friday.